Provider Demographics
NPI:1154481976
Name:LEONG, WANDA SHE-KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:SHE-KIM
Last Name:LEONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 PARAMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1326
Mailing Address - Country:US
Mailing Address - Phone:650-634-8022
Mailing Address - Fax:
Practice Address - Street 1:256 N SAN MATEO DR
Practice Address - Street 2:STE. 6
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2624
Practice Address - Country:US
Practice Address - Phone:650-343-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist